Acute Acalculous Cholecystitis in a Child with COVID-19 and Influenza B: A Case Report

BACKGROUND Acute acalculous cholecystitis (AAC) is a rare pediatric condition marked by gallbladder inflammation without gallstones. In children, symptoms are non-specific, making diagnosis and management challenging. Imaging, particularly ultrasound or computed tomography (CT) scan, often is the key to detection. Treatment typically involves supportive care and antibiotics, with surgery reserved for severe cases. This report describes the case of a 7-year-old Malaysian boy with a history of COVID-19 and influenza B infection presenting with acute acalculous cholecystitis. CASE REPORT A 7-year-old Malaysian boy presented with fever, vomiting, and abdominal pain, initially diagnosed as acute gastroenteritis at primary care clinic. As symptoms worsened, he went to the Emergency Department, where he tested positive for COVID-19 and influenza B and home quarantine was advised. He had another visit the next day in the same hospital and was given symptomatic treatment. On his fourth visit, due to worsening abdominal pain, he was found to have severe transaminitis and coagulopathy. A CT scan revealed AAC, which was managed conservatively. Treatment with intravenous immunoglobulin (IVIG) therapy led to marked clinical and biochemical improvement within 1 week. CONCLUSIONS This case highlights the importance of early identification of complications associated with COVID-19 and influenza B, as conditions such as acute acalculous cholecystitis can present with atypical symptoms in children, making diagnosis more challenging. Prompt recognition and proper referral from primary care settings are vital to prevent diagnostic delays, ensure effective management, and ultimately improve patient outcomes while preventing further complications.